Lonelygenic environments: a call for research on multilevel determinants of loneliness
Authors: Xiaoqi Feng, Thomas Astell-Burt
Journal: The Lancet Planetary Health (2022)

Loneliness is a felt deprivation of connection, companionship, and camaraderie. At least a quarter of adults are reported to experience persistent loneliness and the consequences can be highly detrimental to mental and physical health.1Rico-Uribe LA Caballero FF Martín-María N et al.Association of loneliness with all-cause mortality: a meta-analysis.PLoS One. 2018; 13: e0190033Crossref PubMed Scopus (273) Google Scholar Amid increasing evidence of the harms that loneliness can cause or aggravate, the UK Government appointed a Minister for Loneliness in 2018. Japan followed in 2021. However, actions to address loneliness tend to be mental health oriented, treatment focused, and weak or ineffective.2Akhter-Khan SC Au R Why loneliness interventions are unsuccessful: a call for precision health.Adv Geriatr Med Res. 2020; 4: e200016Google Scholar Unfortunately, despite being in the era of planetary health, narratives on loneliness and what can be done to address it tend to ignore potentially powerful and dynamic environmental influences. To isolate this aversive state as a problem with a person to be treated is erroneous and does not emphasise the most crucial and important factor: loneliness is not an illness, but a feature of urban planning and societal systems that have not prioritised people's health and social needs. Without disrupting the conditions that entrench loneliness, to which some groups of people are likely to be more vulnerable than others, we are setting up investments in person-focused remedies for failure. Across 2022, we have engaged a range of consumer and community groups to discuss determinants of loneliness. It has become very clear that it is not simply because one might be older, introverted, a wheelchair user, born in a different country, or single that the risk of becoming lonely is elevated. It is the shortsighted, inadvertant, reckless, and negligent decisions made across society, fostering stigma and structural discrimination (racism, sexism, ableism, classism), that generate social and built environments that make many people with these characteristics feel perpetually isolated and unsafe. Perhaps there is no better example than the near universal prioritisation of cars over people across societies. Slicing through communities, roads are often noisy arteries throbbing with traffic and cluttered with parked vehicles, depriving people of places to meet. Encouraging sprawl and lengthening distances to get basic goods and services, this dependency on cars has erased serendipitous opportunities to stop and get to know one's neighbours in meaningful ways. Electric vehicles will not change this. Meanwhile, the systematic felling of street trees and a failure to maintain new plantings in many cities has deprived pedestrians of the natural umbrellas that provide protection against the rain and heat. This, along with the neglect and whittling down of public green spaces, disproportionately in lower-income communities, is depriving people of the settings where nourishing connections and community spirit can be fostered.3Astell-Burt T Hartig T Eckermann S et al.More green, less lonely? A longitudinal cohort study.Int J Epidemiol. 2022; 51: 99-110Crossref PubMed Scopus (41) Google Scholar One only needs to consider recent evidence of how visiting a quality green space during the COVID-19 pandemic was associated with greater odds of keeping connected, exercising, and finding solace.4Feng X Astell-Burt T Perceived qualities, visitation and felt benefits of preferred nature spaces during the COVID-19 pandemic in Australia: a nationally-representative cross-sectional study of 2940 adults.Land. 2022; 11: 904Crossref Scopus (15) Google Scholar Car dependency and loss of tree canopy not only discourage social connections and physical activity, but also indirectly weaken our connections with the more-than-human world that nurtures pro-environmental behaviours5DeVille NV Tomasso LP Stoddard OP et al.Time spent in nature is associated with increased pro-environmental attitudes and behaviors.Int J Environ Res Public Health. 2021; 18: 7498Crossref PubMed Scopus (30) Google Scholar and, for many of us, is an important source of resilience.6Birch J Rishbeth C Payne SR Nature doesn't judge you—how urban nature supports young people's mental health and wellbeing in a diverse UK city.Health & Place. 2020; 62: 102296Crossref PubMed Scopus (72) Google Scholar No wonder there seems to be rising demand for health professionals in many countries to prescribe time in nature as an adjunct to standard medical care.7Astell-Burt T Pappas E Redfern J Feng X Nature prescriptions for community and planetary health: unrealised potential to improve compliance and outcomes in physiotherapy.J Physiother. 2022; 68: 151-152Crossref PubMed Scopus (6) Google Scholar Within this context, it is easy to understand the appeal of smartphones and social media as a medium through which people might try to transcend local circumstances and connect with community. But online connections do not necessarily translate into companionship, and social expectancies of projecting happiness online can leave people feeling sadder and more alone.8Bastian B Koval P Erbas Y et al.Sad and alone: social expectancies for experiencing negative emotions are linked to feelings of loneliness.Soc Psychol Personal Sci. 2015; 6: 496-503Crossref Scopus (26) Google Scholar Drawing inspiration from previous work on environmental determinants of obesity, we have coined the term lonelygenic environments to mean those complex contextual conditions that can cause or aggravate loneliness. We have taken an existing conceptual framework on green space and loneliness9Astell-Burt T Hartig T Putra IGNE et al.Green space and loneliness: a systematic review with theoretical and methodological guidance for future research.Sci Total Environ. 2022; 847: 157521Crossref PubMed Scopus (27) Google Scholar and made two important adaptations for the purposes of generalising across contexts, local and global. The first adaptation is acknowledging the prevailing stigma towards loneliness and structural discrimination present in many forms that infuses the environments to which people are exposed or excluded from. Interventions to reduce these factors will help but work to reduce loneliness cannot stop there. The second adaptation integrates multiple physical and virtual environments, including third places outside of the settings in which people live and work (eg, a park, library, or cafe). Collectively, these are the settings across which complex social interactions take place and provide opportunities for targeting interventions. Whether such interactions catalyse quality connections or leave people feeling alone depends on the congruence of personal and place circumstances. For example, regeneration of an area might create new opportunities for connection, but also exclude those worried about declining housing affordability. Another example is the social exclusion of people living with physical disability from parks that lack suitable accessibility.10Perry M Cotes L Horton B et al."Enticing" but not necessarily a "space designed for me": experiences of urban park use by older adults with disability.Int J Environ Res Public Health. 2021; 18: 552Crossref PubMed Scopus (15) Google Scholar Such circumstances can mean that places facilitate connection for some but marginalisation for others. Consideration of multilevel factors and the collective, relational, and personal experiences we have with them is essential to define the scale of harm caused and the potency of potential solutions, whether they be capacity building, restorative, or harm reducing in nature (figure). We call for research to establish a foundation of evidence that measures lonelygenic environments, which could vary from place to place, and to integrate that evidence into optimising loneliness reduction strategies that work for everyone. We declare no competing interests. TA-B and XF are joint corresponding authors. They are founding co-directors of the Population Wellbeing and Environment Research Lab (PowerLab). Loneliness as a health issueLoneliness is not new, but it does seem to be gaining attention as a social and health concern. The UK and Japan appointed ministers of loneliness in 2018 and 2021, respectively. The US Surgeon General recently called loneliness a public health problem on the scale of smoking: as damaging to physical health as 15 cigarettes per day. The COVID-19 pandemic—necessitating periods of physical distancing and changing the way many structure their working lives—has brought the issue of loneliness to the forefront. Full-Text PDF